Provider Demographics
NPI:1316420342
Name:PANG, WYSON (RPH)
Entity type:Individual
Prefix:
First Name:WYSON
Middle Name:
Last Name:PANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 DOGWOOD AVE APT 20B
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-5305
Mailing Address - Country:US
Mailing Address - Phone:510-541-4465
Mailing Address - Fax:
Practice Address - Street 1:899 DOGWOOD AVE APT 20B
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-5305
Practice Address - Country:US
Practice Address - Phone:510-541-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist